November 28, 2011

Centers for Medicare and Medicaid (CMS) Administrator Donald Berwick, MD resigned in the face of Republican pledges to block his confirmation in the Senate. Berwick had been appointed during a congressional recess and faced significant challenges in the Senate. He notified colleagues that he will step down Dec. 2, nearly a month before the expiration of his recess appointment.

The White House will nominate Marilyn Tavenner, Medicare’s deputy administrator, as his replacement. An article in the Washington Post noted that, “Republicans have responded cautiously to the White House’s nomination of Tavenner, a former nurse and hospital administrator who has served in the Obama administration since February 2010. She was Virginia’s secretary of health and human resources under then-Gov. Tim Kaine (D).”

Tavenner’s appointment requires confirmation by the Senate. It’s likely that hearings will not be scheduled until next year. Tavenner will serve as acting administrator until her appointment is confirmed.

In announcing her nomination, the White House highlighted Tavenner’s nearly 35-year health-care career, “including almost 20 years in nursing, 3 years as a hospital CEO and 10 years in various senior executive level positions for Hospital Corporation of America.” Tavenner earned both a nursing degree and a Master's in Health Administration from Virginia Commonwealth University in Richmond.

Sen. Orrin Hatch (R-Utah), ranking member of the Senate Finance Committee, said, “Republicans on the Finance Committee look forward to examining her record and gaining an understanding of her views of Medicare, Medicaid and the presi­dent’s health law.”

Berwick Era

“Don Berwick did outstanding work at CMS,” White House deputy press secretary Jamie Smith said Wednesday. “It’s unfortunate that a small group of senators obstructed his nomination, putting political interests above the best interests of the American people.”

Obama nominated Berwick to run Medicare in April 2010. In July 2010, with no confirmation hearing scheduled, the president appointed him to the job while Congress was in recess. As a recess appointment, Berwick’s term was to expire Dec. 31. Earlier this year, 42 Republican senators signed a letter pledging to block his confirmation, effectively ending any chance of him serving beyond 2011.

"As CMS now has the responsibility for restructuring insurance markets across the country [under the Affordable Care Act], Dr. Berwick's lack of experience in the areas of health plan operations and insurance regulation raise serious concerns about his qualifications for this position," they wrote.

“It was a mistake to recess-appoint him,” said Sen. John Barrasso (R-Wyo.), who has been a vocal Berwick critic. “He was the wrong person for the job, and I think it was wrong of the president to make an end run around Congress.”

A Harvard-educated pediatrician, Berwick won accolades and the endorsements of major health-care groups for his academic work, which focused on reducing the cost of care while improving quality and patient experience.

“Republicans, however, seized on remarks he made praising Britain’s National Health Service as an “example” for the United States to follow. Many accused him of supporting the “rationing” of services, a claim Berwick has rejected.”

In his 18-month tenure, Berwick oversaw the rollout of crucial health reform regulations that stand to reshape both the private insurance market and the Medicare program. His agency drafted rules for the new health insurance marketplaces, called exchanges, where Americans will be able to compare and buy health insurance plans in 2014.

Berwick also weathered an aggressive backlash to his draft rules for Accountable Care Organizations, a pilot program that is meant to move Medicare away from paying doctors for the volume of services they provide and toward reimbursements based on quality of care. Medical groups reacted much more positively to the final regulations for that program.

The American Hospital Association (AHA) issued a letter commending Berwick for “his commitment and passion to improving health care” and his “openness to always being willing to listen to the hospital field's perspective on how to deliver better care to patients. “

AHA further asserted that, “he was instrumental in paving the way to new forms of payments that allow for greater coordination for patients across the care continuum.” AHA said they “look forward to continuing working with Marilyn Tavenner, a very capable administrator who has been a key player at CMS in her role as principal deputy administrator. Her varied and rich background as a former nurse, health care executive, and government official at the state level gives her a very unique perspective in understanding both the implications of public policy and their implementation. We have no doubt that she will provide strong leadership in these challenging times.

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You might have pointed out that the Brits hired him and he worked with them to restructure their health care to institute the programs and the comment he made, taken out of context as usual, about British health care was after working with them for ten years at their request, and having them incorporate the changes he suggested -- doctor care that ensured tests did not overlap, cleanliness in hospital settings to fight the increasing unsanitary conditions and patients contracting new diseases in the very place they went to heal, and in America, working on insurance company restructuring to ensure lower costs. His meeting with Kyle began with Kyle saying something to the effect of I don't agree with anything you say or do. We've lost another very bright man, a doctor, who would have made a huge difference in health care costs to spite and selfish partisanship.